Maternal health: The Lancet Report

 The Lancet has published a new series of papers on maternal health which reveal that while progress has been made in reducing maternal mortality globally, differences remain at international and national levels.
Highlights of the report:

• In 2015, 216 women died of maternal causes per 100 000 live births—down 44% from 385 per 100 000 in 1990—but still far short of the MDG 5a target of a 75% reduction. The global target for 2030 is 70 per 100 000, requiring a 68% reduction.
• The significant burden of maternal morbidity has become more apparent, with an estimated 27 million episodes from the five main direct obstetric causes alone in 2015
• Three-quarters of women now deliver with assistance from a skilled birth attendant and two-thirds receive at least four antenatal care visits. Nearly 53 million women, concentrated in the poorest countries or among the poorest women within countries, receive no skilled assistance at birth.
• In high-income countries, rates of maternal mortality are decreasing but there is still wide variation at national and international level. For instance, in the U.S., the maternal mortality ratio is 14 per 1,00,000 live births compared to 4 per 1,00,000 in Sweden. Nigeria shouldered the maximum burden of 58,000 maternal deaths.
• The sub-Saharan African region accounted for an estimated 66% (2,01,000) of global maternal deaths, followed by southern Asia at 22% (66,000 deaths). However, not all care is evidence-based, and improved surveillance is needed to understand the causes of maternal deaths when they do occur.
• There are also new challenges in delivering high quality care, including the increasing age of pregnancy, and higher rates of obesity.
• While facility and skilled birth attendant deliveries are increasing in many low-income countries, phrases such as ‘skilled birth attendant’ and ‘emergency obstetric care’ can mask poor quality care. Besides, many birth facilities lack basic resources such as water, sanitation and electricity.
• Also, measuring progress via the current indicator of skilled birth attendant coverage is insufficient and fails to reflect the complexity of circumstances. It is also unethical to encourage women to give birth in places with low facility capability, no referral mechanism, with unskilled providers, or where content of care is not evidence-based. This failing should be remedied as a matter of priority.
• According to the report, there are two broad scenarios that describe the landscape of poor maternal health care — the absence of timely access to quality care (defined as ‘too little, too late’) and the over-medicalisation of normal and postnatal care (defined as ‘too much, too soon’).

Analysis:

• Antenatal care and skilled health attendance at delivery are essential for eliminating every preventable maternal death. The world, as a whole, has improved access to these services, with 71 per cent of women delivering with the support of a skilled birth attendant in 2014, compared to 59 per cent in 1990, progress has not been fast enough.
• As a part of SDGs(Sustainable development goals), the UN aim to reduce the global mortality rate to less than 70 per 100,000 live births by 2030, as well as ensure there is universal access to sexual and reproductive health care services.
• In order to provide better facilities High-quality maternal health care services should be provided that can address patients' individual needs should be put in place across the globe.
• Each country needs a clear national statement of what care needs to be provided to pregnant women, what constitutes routine care for uncomplicated deliveries, and what mechanisms are required to respond on a timely basis to complicated deliveries, including referral linkages
• Countries also need to carefully compare this national statement with their present situation using tools such as facility and population-based surveys, or routine information systems.
• There should also be universal access to high-quality maternal health services, as a way of ensuring all women and babies receive equal care, regardless of where they are in the world.
• Every universal health coverage initiative should include a strong maternal health service core and ensure that it reaches every woman, everywhere with quality care, and without causing financial hardship and pushing families into poverty.
• Health systems worldwide also need to be strengthened, which incorporates better training of maternal health care providers and improvements in birth facilities.

By: Vishal